Home Health Insurance Health Insurers: Time to Bring the Game to the Consumers

This year’s AHIP Operations and Technology forum communicated a clear message: Success for health care payers and providers hinges on the ability to reach consumers. To quote from the closing session, “Build it and they will come is a failure. Bring the game to the consumer.” What consumers need to feel comfortable purchasing health coverage and maximizing benefit use is likely to shape where the industry goes next.

Consumers are looking for buying health insurance to be as easy as purchasing an airplane ticket or ordering a book from Amazon. More specifically, consumers want:

  • Costs to be available and transparent.
  • The ability to easily compare benefits and health care options.
  • To be approached as consumers, as opposed to “insureds” or “patients”.
  • Messaging that demonstrates authentic understanding of individual consumer needs – down to cultural and community preferences, preferred communication modes, and information shared through terms and visual tools consumers find meaningful.

The health insurance industry is in sync with consumers’ desire to be met where they are. According to one presentation, of 40 health plans surveyed, the topmost concern is consumer engagement. The options offered for achieving this?

Individuation. One message or outreach approach can no longer fit all. High-level market segmentation seems to be giving way to “audience fragmentation” (a phrase used by featured speaker Bill Lan – Google’s Head of Industry, Insurance & Services). Reliable, consistent, accurate and empathetic communications can make a big impact in motivating consumers to respond. Acknowledgement of “small data” can matter as much as “big data” – for example, addressing a consumer with appropriate gender references.

Increased payer-provider integration – to close the “care gap” between consumer benefits, care choices, and consumer health care needs. A shift towards care pathways is one emerging trend – management of collective episodes of care, as opposed to disparately managed procedures and treatments. Payer-provider integration at the point of care is also gaining momentum – providing value by streamlining cost transparency and lessening payer, consumer, and provider administrative burdens. One innovation in this area is Wellero’s (free) smartphone app, which allows consumers to complete an insurance eligibility check, understand cost before a service is provided, and complete payment at the time of service (eliminating surprise bills). A further evolution to watch for is providers offering their own products on exchanges.

Predictive and segmentation analytics. Predictive analytics performed against clinical and claims data can proactively contain cost by increasing efficiency and improving health outcomes – benefitting consumers, providers, and carriers alike. As LexisNexis emphasized, information about the “now” state of patients can be used to identify and proactively treat patients at risk for high-cost services, mitigating health risks while reducing costs. Analytics performed against data about consumer demographics and behaviors can be used to create additional convenience for consumers, while allowing providers and insurers to know who a consumer is and provide appropriate prompts for taking advantage of benefits and care options.

Value determination and transparency. There is evidence that cost and quality do not necessarily trend upward together – and that consumers tend to rely on higher cost as an indication of higher quality. There is an opportunity to reduce costs for consumers, insurers, and providers by providing consumers with easy-to-use tools for assessing and communicating quality and shopping options.

Stay agile. Reduce consumer friction by remaining light and agile in the evolution of technology solution. As recommended by Kony, “write once, build everywhere” – to leverage a single code base across different devices. And remember that content is portable. Reuse options can increase the feasibility of maintaining the array of communication channels preferred by various consumer groups.

The sessions generally looked past concerns around healthcare.gov, focusing on longer term options for the newly retail-focused industry. We look forward to seeing how these trends and further changes develop through 2014.

Leave a Reply